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Figure 1. The
human pancreas. (A) View of the
pancreas showing clusters of acinar cells (i.e., acini), islet cells (i.e.
islets), and pancreatic ducts. (B) An enlargement of a secretory region of
the pancreas. Acini secrete digestive
enzymes into the small intestine, islets secrete the hormones insulin and
glucagon into the bloodstream to regulate blood glucose concentration, and
duct cells secrete bicarbonate to regulate small intestine acidity
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Pancreas: Function
The pancreas is a small
organ, approximately six inches long, located in the upper abdomen, and
adjacent to the small intestine. It lies toward your back. Because it is so deep within your body,
doctors have difficulty diagnosing disease in the pancreas.
The
Pancreas
Completes the job of breaking down protein,
carbohydrates, and fats using digestive juices of pancreas combined with juices
from the intestines.
Secretes hormones that affect the level of
sugar in the blood.
Produces chemicals that neutralize stomach
acids that pass from the stomach into the small intestine by using substances
in pancreatic juice.
Contains Islets of Langerhans, which are tiny
groups of specialized cells that are scattered throughout the organ.
- These cells secrete:
- Glucagon—raises the level of glucose (sugar)
in the blood
- Insulin—stimulates cells to use glucose
- Somatostatin—may regulate the secretion of
glucagons and insulin.
Pancreatitis
Pancreatitis is a rare disease that is not
fully understood.
Pancreatitis is an inflammation of the
pancreas which causes severe abdominal pain—may be either a brief or recurring
problem.
Mortality rate of patients with alcoholic
pancreatitis is about 36% higher than that of the general population.
Annual incidence of acute pancreatitis in Native
Americans is 4/100,000.
The link between alcohol abuse and pancreatic
damage was first seen by N. Friedreich in 1878.
In the United States there is a wide variation
in the percentage of pancreatitis cases that are attributed to alcoholism. The statistics range from 5% to 90%
depending on the population studied.
This disparity in the statistics is caused by the difficulty doctors
have in identifying the cause of this disease.
Since only 5-10% of heavy drinkers develop
pancreatitis, other factors may contribute to the onset of this disease; these
factors may include genetics or nutritional factors.
There are two types of
pancreatitis, acute and chronic.
Acute
Pancreatitis:
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Figure
2. Acute pancreatitis. Photo from Mosby’s dictionary 5th
edition (Fletcher and McKee) |
50,000-80,000 cases of acute pancreatitis
occur in the United States each year.
Acute
pancreatitis is when the pancreas suddenly becomes inflamed and then gets better.
A
person may have more than one attack but recover fully after each one.
The most common cause
of acute pancreatitis in the United States is alcohol abuse.
Causes: Either alcohol
abuse or gallstones, in some cases the cause is unknown but may actually be
due to alcohol use in a person predisposed to pancreatic problems.
Symptoms:
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20%
of pancreatitis cases are very severe; the patient becomes dehydrated, with low
blood pressure. In the most severe
cases, bleeding in the pancreas occurs which can lead to shock and sometimes
death.
**It is important to seek
medical attention as soon as possible.
Acute pancreatitis can be fatal**
Treatment: Treatment
depends on how bad the inflammation is.
Unless there are complications, the condition usually gets better on its
own after a few days.
For the patient’s relief:
Fluids are injected by vein to restore blood
volume.
Kidneys and lungs may be treated to prevent
failure of those organs.
Antibiotics may be given if there is an
infection.
Surgery may be needed if complications such as
infection cysts or bleeding occurs.
Medication may be prescribed to reduce
production of pancreatic juices.
Painkillers may be given.
Chronic Pancreatitis:
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Figure 3. Chronic pancreatitis,
scarring and calcification(calcium deposits) of pancreas. Photo from Mosby’s Dictionary 5th
edition (Fletcher and McKee). |
Symptoms for chronic and acute pancreatitis may
be similar making it difficult for doctors to differentiate between the two.
The pancreas becomes permanently damaged and
unable to supply a sufficient amount of hormones and digestive juices.
First acute attack usually occurs after a
binge-drinking episode.
Attacks become more frequent and the pain
becomes more persistent and severe.
Pancreatic calcification occurs about 8-10
years after the first clinical presentation of the disease.
Chronic pancreatitis may develop after one
acute attack especially if ducts become damaged.
This disease is more common in men than women,
and typically the patient is diagnosed at 30-40 years of age.
Damage to the pancreas from drinking may have
no symptoms for many years; then a patient may experience the sudden onset of
pancreatitis.
Chronic pancreatitis causes three main kinds of problems:
Poor absorpbtion of food leading to weight
loss
Pain
Diabetes, if islets of Langerhans are
damaged.
Whether you are a chronic drinker
or a binge drinker doesn’t seem to make a difference; the risk for chronic
pancreatitis increases with time and amount of alcohol consumed.
Seventy percent of chronic pancreatitis cases are caused by
chronic alcohol abuse.
Three to four standard drinks per day over a
10 year period is the average alcohol consumption seen in patients who develop
clinically significant chronic pancreatitis.
Life expectancy of patients with advanced
disease is typically shortened by 10-20 years.
Chronic pancreatitis can progress even after
you stop drinking alcohol.
There is such a difference between each person
that it is not possible to say that even small amounts of alcohol are safe.
It has been suggested that the specific risk
of pancreatic cancer among alcoholics may be limited to those alcoholics who
develop chronic pancreatitis. The
relationship is not clear because of contributing factors such as malnutrition
and smoking which are commonly associated with alcohol abuse.
Treatment:
Painkillers
Enzyme tables to help digest food
Special diet
Surgery
AVOID ALCOHOL, ADHERE TO PRESCRIBED DIETS, AND TAKE PROPER MEDICATION TO HAVE FEWER AND MILDER ATTACKS OF PANCREATITIS